Red flags are symptoms which show a serious spinal condition or disease. Some types of back pain caused by infection or cancer are serious. These may need immediate medical attention. These causes are very rare and should not cause unnecessary worry. Majority of back pain is just mechanical. One of the red flags in back pain is severe and debilitating back pain that is present even at rest. This sort of back pain can cause sleep disturbance. The usual red flag symptom is severe back pain. The back pain may not relieved by rest. New onset of severe back pain in the elderly, fever, and progressive weakness or numbness in the legs or arms. Some may be unable to pass water / urine and may develop numbness in the saddle area.
Like “red flags”, professionals also use the term “yellow flags”. Yellow flags describe back pain that may have a psycho-socio-economic element. These are the patients whom some may describe as “mad”. This may be because nothing may be physically wrong with their back. To label these patients as “mad” is cruel and unsympathetic. The pain and the problems that the patient faces are real and it needs to be addressed. Physiotherapy alone may not be the best way to treat back pain with yellow flags. Patients with yellow flags may have other factors that affect their well-being. These patients may need psychological help as well. Yellow flags can develop following an accident, a depressive episode and anxiety. Fear of movement (Kinesiophobia) is common with yellow flags. Psychotherapy and gentle encouragement will help these patients onto the road to recovery. These patients are in a dark place and need a lot of encouragement to crawl out of that place. To label these patients as “mad” or “bad” does not help. This only compounds the problem, both for the patient and for the community.